肾小球滤过率降低会增加急性缺血性脑卒中的出血性转化。

Low glomerular filtration rate increases hemorrhagic transformation in acute ischemic stroke.

机构信息

Department of Neurology, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.

出版信息

Cerebrovasc Dis. 2013;35(1):53-9. doi: 10.1159/000345087. Epub 2013 Feb 14.

DOI:10.1159/000345087

PMID:23428997

Abstract

BACKGROUND

Decreased glomerular filtration rate (GFR) can increase the risk of bleeding tendency and hemorrhagic stroke. However, the relationship between the levels of GFR and hemorrhagic transformation (HT) after acute ischemic stroke is largely unknown. The aim of this study was to assess whether GFR level is associated with HT in acute ischemic stroke.

METHODS

We reviewed 770 consecutive patients with acute ischemic stroke within 7 days from September 2007 to February 2012 in a prospective stroke registry database. We calculated the patient's GFR using the Cockcroft-Gault equation, and divided them into 3 groups: ≥60, 30-59 and <30 ml/min/1.73 m(2). HTs were identified by follow-up computed tomography (CT) or magnetic resonance imaging, and were defined as (1) any degree of high density within the area of low attenuation of vascular territory on noncontrast brain CT, or (2) low-signal intensity area in gradient echo within high-signal intensity meaning acute infarct on diffusion-weighted imaging. Multivariable logistic regression analyses were used to estimate the risk of GFR for HT. Stratification analyses were done according to the presence of HT high risk factors: atrial fibrillation (AF), thrombolysis and large size infarction. Additional logistic regression model for symptomatic HTs was established with the same variables.

RESULTS

HTs were noted in 131 patients (17.0%) and symptomatic HTs in 63 patients (8.2%). In univariate analysis, HTs were more frequent in patients with AF (51.9 vs. 16.7%, p < 0.001) and large-size infarction (42.0 vs. 5.3%, p < 0.001). The risk of HT was associated with decreased GFR among 3 subgroups classified according to the value of estimated GFR: 49/394 (12.4%) in the GFR ≥60 group, 66/312 (21.2%) in the 30≤ GFR <59 group and 16/64 (25.0%) in the GFR <30 group (p = 0.002). We found a significant association between the GFR <30 group and HTs in acute ischemic stroke (OR 2.90; 95% CI 1.26-6.68, p = 0.012) after adjusting for other risk factors. Moreover, the incidence of HTs was higher in the subgroups without thrombolysis (OR 3.49; 95% CI 1.44-8.46) and without AF (OR 3.44; 95% CI 1.10-10.76). Decreased GFR also had a tendency of increasing symptomatic HTs (OR 2.39; 95% CI 0.72-7.94, p = 0.154).

CONCLUSIONS

Low levels of GFR are associated with a high risk of HT after acute ischemic stroke. Further studies are needed to elucidate whether HT in the patients with renal insufficiency are related to a worse outcome after acute ischemic stroke.

摘要

背景

肾小球滤过率（GFR）降低会增加出血倾向和出血性中风的风险。然而，急性缺血性中风后 GFR 水平与出血转化（HT）之间的关系在很大程度上尚不清楚。本研究旨在评估 GFR 水平是否与急性缺血性中风后的 HT 相关。

方法

我们回顾了 2007 年 9 月至 2012 年 2 月期间前瞻性卒中登记数据库中 770 例急性缺血性中风患者。我们使用 Cockcroft-Gault 方程计算患者的 GFR，并将他们分为 3 组：≥60、30-59 和<30 ml/min/1.73 m²。通过随访计算机断层扫描（CT）或磁共振成像（MRI）识别 HT，定义为（1）非对比度脑 CT 血管区域内的任何程度高密度，或（2）梯度回波中的低信号强度区域在弥散加权成像中的高信号强度意味着急性梗死。多变量逻辑回归分析用于估计 GFR 对 HT 的风险。根据 HT 高危因素：心房颤动（AF）、溶栓和大梗死面积，进行分层分析。使用相同的变量建立了用于症状性 HTs 的额外逻辑回归模型。

结果

131 例患者（17.0%）出现 HTs，63 例患者（8.2%）出现症状性 HTs。在单变量分析中，AF（51.9% vs. 16.7%，p<0.001）和大梗死面积（42.0% vs. 5.3%，p<0.001）患者中 HTs 更常见。根据估计的 GFR 值将患者分为 3 个亚组，在这 3 个亚组中，HT 的风险与 GFR 降低相关：GFR≥60 组 49/394（12.4%），30≤GFR<59 组 66/312（21.2%），GFR<30 组 16/64（25.0%）（p=0.002）。在调整其他危险因素后，我们发现 GFR<30 组与急性缺血性中风后 HTs 之间存在显著相关性（OR 2.90；95%CI 1.26-6.68，p=0.012）。此外，无溶栓（OR 3.49；95%CI 1.44-8.46）和无 AF（OR 3.44；95%CI 1.10-10.76）亚组中 HTs 的发生率更高。GFR 降低也有增加症状性 HTs 的趋势（OR 2.39；95%CI 0.72-7.94，p=0.154）。